Saturday, 25 October 2014

2013: 17,400 women succumb to maternal deaths


By: CHIOMA UMEHA

The maternal and child mortality situation in the country has continued to worsen with Nigeria still retaining the second highest global burden of maternal deaths in the world next to India. Dr. Oluwarotimi Ireti Akinola, Chairman, Society of Gynaecology and Obstetrics in Nigeria (SOGON), Lagos Sector–in an interview with CHIOMA UMEHA (HEALTH EDITOR) gives an overview of maternal and child mortality reduction programme in the country. Excerpts:

Oluwarotimi Ireti Akinola
Why are pregnancy-related health complications and deaths on the increase?
Pregnancy is not a disease but privileged function entrusted to women. However it has become such a great battle that many have lost their lives in the struggle.  Following the rise on the incidence of pregnancy-related health complications and deaths, Prof Mahmoud Fathalla commended the English term used to describe what women do to give birth to a child as ‘labour.’ Unfortunately this is ‘labour that has never been unionized’ and has therefore suffered neglect.

Many still remember with sadness the plane crash of last year, in which more than 130 people died. If any country has a plane crash which kills 145 passengers daily, which is an equivalent of the estimated daily maternal deaths in Nigeria, there would be serious crisis. It is safe to assume that about 17,400 Nigerian women have died due to pregnancy- related issues this year, from January to April. This is because 145 women die daily due to pregnancy-related reasons in the country. In addition, for every woman who dies, approximately 20 more experience infection, injuries or disability.

Define maternal death?
Maternal death is the death of a woman during pregnancy or within 42 days of termination of pregnancy, due to reasons related to pregnancy or its management. This is irrespective of the duration of the pregnancy. Late maternal death is the death of a woman due to direct or indirect obstetric causes, more than 42 days, but less than one year after termination of pregnancy. Despite being caused by pregnancy-related events, these deaths do not count as maternal deaths in routine civil registration systems.

Assess maternal death situation in the country?
Nigeria is home to one out of five Africans, with its population of over 160 million that is estimated to be one per cent of the global population. The country however, accounts for a disproportionate 10 per cent of global maternal deaths. Nigeria presently has one of the highest maternal mortality rates in the developing world – accounting for the second highest global burden of maternal deaths in the world next to India. The last National Demographic and Health Survey in 2008 placed the national Maternal mortality Rate at 545 per 100,000 live births ,this is unacceptably high when compared to 350/100,000 and 400/100,000 in Ghana and Benin Republic respectively over the same period of time. This is even as the February 2009 UNICEF report, showed that the figures were under-estimated. The report stirred the hornet’s nest when it updated its earlier estimation of the incidence of maternal mortality in Nigeria from 800 per 100, 000 to 1,100 per 100,000 live births, an indication that the strategies to address the situation were not yielding anticipated results. This created uproar in government circles that warranted the then minister of information and communication issuing a political statement to refute the information.

What is the prenatal mortality situation in the country?
Prenatal mortality tends to follow the same geographical pattern as maternal mortality. 3.3 million still-births occur yearly, while over four million newborns die during the first 28 days of life, even as three million dies during the first seven days. In developing countries, about one third of these deaths are related to prenatal complications responsible for birth asphyxia.

Assess efforts to address maternal and infant mortality problems in the country?
Many acronyms representing programmes have been designed to address maternal and infant mortality issues since the past 20 years in the country. These include: SMI (Safe Motherhood Initiative), MPS (Making Pregnancy Safer), LSS (Life Saving Skills), IMNCH (Integrated Maternal, Newborn and Child health) and MSS (Midwife Service Scheme). Others are: EOC (Essential Obstetric Care), EMOC (Emergency Obstetric Care), IMCI (Integrated Management of Childhood Illness) and MDGs (Millennium Development goals). Huge funds have been directed to execute these programmes which are so many that even those who coined them can be forgiven if they forget their meanings.

Give the data of maternal and infant mortality rates in the country?
Published maternal mortality rates in the country have been particularly diverse and sometimes contradictory depending on their sources. For instance, it was 800/100, 00 based on the Federal Ministry of Health (FMOH) 2000 survey; the figure was high as 3,000/100,000 according to Society of Gynaecologists and Obstetricians of Nigeria (SOGON) 2004, while the National Demographics Health Survey (NDHS) 2008 gave the figure as 545/100,000. The Lagos State Survey 2010 showed 555/100,000 at the state level; in Alimosho LGA- 826/100,000 and Ibeju- Lekki LGA- 758/100,000. The Lagos State Survey 2010 further showed the following figures: Ikorodu –    754/100,000; Ikeja -354/100,000; Surulere- 332/100,000; Lagos Island- 310/100,000 and Lagos Island- 310/100,000. According to another statistics: “Woman’s chance of dying from pregnancy and childbirth in Nigeria is one in 13 compared to one in 1750 (developed countries), one in 870 (East Asia), one in 90 (Latin America), one in 24 (Africa).” There is also a wide disparity in the burden of maternal death across the country: for instance, the north-eastern zone of the country having almost ten times the number of deaths that occur in the south-western zone.

How can the problem of maternal and infant mortality be addressed?
The second out of Prof M. Fathalla’s 10 propositions for safe motherhood for all women is recommendable in addressing the issue. It stated that “maternity is special and society has an obligation to make it safe. It further said; “pregnancy is not a disease. It is the means for the survival of our species. All women have a basic human right to be cared for and protected when they undertake the risky journey of pregnancy and childbirth, and society has an obligation to fulfil this. Safe motherhood is a human rights issue for which countries should be held accountable.”

Identify major causes of maternal mortality in the country?
The major causes are haemorrhage, infection, hypertensive disorders of pregnancy, obstructed labour and anaemia.  It is important to state that utilising available know how as at today will render most of the deaths preventable. Maternal death is however is a consequence of  three levels of delay , including: Delay in seeking health care, delay in accessing health care and  delay in receiving help at the health centre.  Any effort to drastically reduce maternal mortality rates must address the root causes of these delays.

Discuss infant mortality?
The World Health Organisation (WHO) published 10 facts on child health which include; “A child’s risk of dying is highest in the first month of life. Three million children die every year within a month of their birth Pneumonia is the largest single cause of death in children under five years of age. The WHO report further stated; “diarrhoeal diseases are a leading cause of sickness and death among children in developing countries Every 45 seconds a child dies from malaria in Africa. “Over 90 per cent of children with HIV are infected through mother-to-child transmission. About 20 million children worldwide suffer from severe acute malnutrition. Three-quarters of child deaths occur in Africa and South-East Asia, the report said. Two-thirds of child deaths can be prevented through increased investment, according to WHO. In this regard, the Lagos State Government established the maternal and child mortality reduction programme, to address the situation.

Assess maternal and child mortality reduction programme in Lagos state?
The Lagos State Maternal and Child Mortality Reduction Programme Advisory Committee was established by the Ministry of Health in year 2008 to map out strategies and activities for the reduction of the unacceptably high maternal and child mortality rate in the state.  It is made up of relevant stakeholders drawn from Society of Gynaecologists and Obstetricians of Nigeria (SOGON), Paediatrics Association of Nigeria, Lagos State University Teaching Hospital (LASUTH), Association of Private Medical Practitioners of Nigeria (AGPMPN), Lagos State Board of Traditional Medicine Board (LSTMB), Lagos State Primary Health Care Board (co-opted after board inauguration in February 2009), Local Government Service Commission, Ministry of Local Government and Chieftaincy Affairs, Ministry of Women Affairs and Poverty Alleviation and officials in the Ministry of Health. The committee developed a five year work-plan for the implementation of activities aimed at accelerating attainment of the Millennium Development Goals 4 and 5. The work-plan was designed to improve the health seeking behaviour of women and children and also improve the quality of health services rendered.

The work-plan was marked with the launch of the maternal and child mortality reduction programme, by Governor Babatunde Raji Fashola on Thursday October 18, 2012. This date was named the Maternal and Child Mortality Reduction Programme Day by the Governor, during which the state and respective LGAs/LCDAs gives report of all programmes aimed at improving the health of mothers, pregnant women and children. The District Town Hall meetings are designed to ensure that key messages get to the grass roots where the maternal and child health interventions are needed most. A major focus is public enlightenment/sensitization and community mobilization. In this regard, series of town hall meetings are being planned on a Senatorial District basis. The first town hall meeting took place in Lagos west 1 Senatorial District on March 21, 2013 at Oshodi-Isolo LGA. LGAs/LCDA within the District include Mushin, Alimosho, Ifako-Ijaiye, Ikeja and Oshodi-Isolo) and the corresponding LCDAs.

 This story was published in Daily Newswatch on May 23, 2013.

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